Jiang Rui, Luo Cong-Feng, Wang Ming-Chun, Yang Tie-Yi, Zeng Bing-Fang
Department of Orthopaedic Surgery, Shanghai Gongli Hospital, and Shanghai JiaoTong University, Shanghai, PR China.
Knee. 2008 Mar;15(2):139-43. doi: 10.1016/j.knee.2007.12.001. Epub 2008 Jan 24.
The present investigation is a prospective study comparing the use of locked plates and classic double plates for the repair of bicondylar tibial plateau fractures. Eighty-four patients with bicondylar tibial plateau fractures were treated with plate fixation by either a locked plate (Less Invasive Stabilization System, LISS) or classic double plates (DP). All patients were followed for a minimum of 24 months. Outcomes were assessed by recording the surgical experience with each approach, post-operative complications and improvements in knee function as measured by the Hospital for Special Surgery (HSS) score. For all patients, no differences in the mechanisms of injury, fracture type, open fracture grade, mean age, gender distribution, associated medical conditions, pre-surgical stay, surgical time, bony union rate or radiographic healing times were observed between the two groups. Also, the HSS score and incidences of infection, seroma, hematoma, deep venous thrombosis, loss of reduction, loss of alignment, hardware failure and overall post-operative complications were all similar in both groups (P>0.05). Wound size and blood loss were significantly less in the LISS group than in the DP group (both P<0.05). A significantly higher incidence of post-operative malalignment of the proximal tibia (P=0.041) and a trend toward significance of a higher incidence of symptomatic hardware irritation (P=0.057) were observed in the LISS group compared to the DP group. In conclusion, LISS provides an alternative treatment for bicondylar tibial plateau fractures, but it may not replace the conventional two-incision double plating technique as the standard of care.
本研究是一项前瞻性研究，比较锁定钢板和传统双钢板在双髁胫骨平台骨折修复中的应用。84例双髁胫骨平台骨折患者采用锁定钢板（微创稳定系统，LISS）或传统双钢板（DP）进行钢板固定治疗。所有患者均随访至少24个月。通过记录每种方法的手术经验、术后并发症以及用特殊外科医院（HSS）评分衡量的膝关节功能改善情况来评估结果。对于所有患者，两组在损伤机制、骨折类型、开放性骨折分级、平均年龄、性别分布、相关内科疾病、术前住院时间、手术时间、骨愈合率或影像学愈合时间方面均未观察到差异。此外，两组的HSS评分以及感染、血清肿、血肿、深静脉血栓形成、复位丢失、对线丢失、内固定失败和总体术后并发症的发生率均相似（P>0.05）。LISS组的伤口大小和失血量明显少于DP组（均P<0.05）。与DP组相比，LISS组观察到胫骨近端术后对线不良的发生率显著更高（P=0.041），且有症状的内固定刺激发生率更高的趋势（P=0.057）。总之，LISS为双髁胫骨平台骨折提供了一种替代治疗方法，但它可能无法取代传统的双切口双钢板技术作为标准治疗方法。
